Healthcare Provider Details

I. General information

NPI: 1649492430
Provider Name (Legal Business Name): BRYCE A. MORTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 E ELDER ST
FALLBROOK CA
92028-3004
US

IV. Provider business mailing address

2004 MIL SORPRESAS DR
FALLBROOK CA
92028-1833
US

V. Phone/Fax

Practice location:
  • Phone: 760-731-8152
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG75727
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: